MRSA colonization and infection among persons with occupational livestock exposure in Europe: Prevalence, preventive options and evidence.

Colonization with livestock-associated Methicillin-resistant Staphylococcusaureus (LA-MRSA) among persons occupationally exposed to pigs, cattle or poultry is very frequent. In Europe, LA-MRSA mostly belong to the clonal lineage CC398. Since colonized persons have an increased risk of developing MRSA infections, defining the burden of work-related infection caused by LA-MRSA CC398 is of interest to exposed personnel, insurance companies and infection control staff. This review summarizes data on the types of occupation-related infections caused by LA-MRSA CC398, the incidence of such infections as well as potential preventive strategies. We identified twelve case reports on infections among livestock-exposed persons. Overall, there is a lack of data describing the incidence of occupation-related infections due to MRSA CC398. Currently, no specific guidance towards the prevention of LA-MRSA CC398 colonization of persons with routine exposure exists. In vitro, MRSA CC398 strains are susceptible (>95%) to mupirocin. Single reports have described effective decolonization of persons carrying LA-MRSA CC398, but long-term success rates are low in case of continuous livestock contact. Overall, the occupational health risk due to LA-MRSA CC398 is not well understood. Currently, prevention of human LA-MRSA CC398 infection is mostly based on the recommendation to perform screening and decolonization therapies prior to elective medical interventions in order to avoid nosocomial infections, but there is no conclusive evidence to perform specific measures aiming to forestall community-acquired infections.